Outline

Introduction: The problem of external ear canal cancers, regardless of the site of origin, is that they are confined to the temporal bone. Besides that they are very rare and clinical presentation is not specific. This leads to a significant delay of diagnosis. Radiotherapy is ineffective and en block resection is the preferable treatment option.

Methods: A retrospective review of the files of our department for the period 1997–2006 identified 4 patients with temporal bone cancers: 3 males and 1 female, age 56–84. Two staged T1 were treated with sleeve resection, one of them recurred and succumbed to the disease. Two were staged T4 and were not treated surgically. This let us admit that diagnosis is retarded and that sleeve resection is not reliable.

Our personal experience encompasses two cases: a male 85 y.o. and a female 79 y.o. Both had squamous cell cancer originating from the pinna and invading the external ear canal. Both underwent lateral temporal bone resection, total parotidectomy and facial nerve sacrifice due to intimate relation to the facial nerve.

Results: In the first case the defect was obliterated with fat and closed with random skin flap. The later however was lost partially and epithelialized by second intention. In the second case the defect was closed two weeks later with temporalis muscle flap to fill the cavity which epithelialized for 10 days. The first patient was lost for follow-up and the second is now 2 years free of disease.

Conclusion: Early diagnosis is extremely important for prognosis of external ear cancer. Lateral temporal bone en block resection and probable total parotidectomy is the preferable treatment modality. Use of temporalis muscle flap is needed for uneventful healing of a large temporal bone defect.